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General NPI Number Information
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NPI Number | 1497371322
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Entity Type | Individual
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Provider Name | LEAH DIANE WOOTEN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 101 N POST RD
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City | MIDWEST CITY
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State | OK
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Zip | 73130-3605
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Country | US
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Telephone | 405-397-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 10305 LYNDON RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-4203
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Country | US
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Telephone | 580-393-1024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5757
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License Number State | OK
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